Paul Sanchez
EmblemHealth is a health and wellness company that provides insurance plans, primary and specialty care, and wellness solutions. It is one of the largest not-for-profit health insurers in the US, serving over three million people in the New York tristate area. EmblemHealth offers a range of individual and family health insurance plans, including Medicare and Medicaid. With a large network of doctors, healthcare professionals, and community resources, EmblemHealth aims to provide personalized and affordable health insurance plans to meet the needs of its members.
| Characteristics | Values |
|---|---|
| Type | Non-profit health insurance |
| Number of Members | Over 3 million |
| Area Covered | New York City and the tristate area |
| History | 80 years |
| Mission | Create healthier futures for customers and communities |
| Services | Insurance plans, primary and specialty care, and wellness solutions |
| Family of Companies | ConnectiCare, AdvantageCare Physicians, and WellSpark |
| Individual Plans | Essential Plan, Millennium Plans (Platinum, Gold, Silver, Bronze, Catastrophic), Select Care Plans (Platinum, Gold, Silver, Bronze, Catastrophic) |
| Family Plans | Millennium Plans, Select Care Plans |
| Group Plans | Small and large groups, labor unions, higher education |
What You'll Learn
EmblemHealth's history and mission
EmblemHealth is one of the largest non-profit health insurance companies in the United States, serving over three million people in New York City and the tristate area. The company was formed in the 1930s, during the Great Depression, from the merger of two early health insurance companies: Group Health Incorporated (GHI) and Health Insurance Plan of Greater New York (HIP).
The idea behind EmblemHealth was to create a system that would protect everyday people from financial hardship in the event of an accident or illness. Over 80 years later, the company's mission remains the same: to create healthier futures for its customers and communities. EmblemHealth is committed to finding new ways to deliver quality care at affordable prices and reinvests in its organisation, members, and communities to do so.
The company offers a range of insurance plans, including individual and family plans, Medicare, and state-sponsored programs such as Medicaid Managed Care and Child Health Plus. EmblemHealth also provides access to top providers and hospitals in the region and offers virtual care options through its Teladoc P360 benefit. In addition to insurance, EmblemHealth provides primary and specialty care through its AdvantageCare Physicians practice and wellness solutions through its digital wellness company, WellSpark.
EmblemHealth's family of companies includes ConnectiCare, a leading health plan in Connecticut; AdvantageCare Physicians, which provides personalised care throughout New York City and Long Island; and WellSpark, which offers a suite of products and solutions to inspire employees to be healthy. With a large network of doctors, healthcare professionals, and community resources, EmblemHealth puts New Yorkers first.
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Individual and family insurance plans
EmblemHealth is a not-for-profit health insurance company that serves over three million people in New York City and the tristate area. They offer a range of individual and family insurance plans, which are designed to provide personalized health insurance at a reasonable price.
Individual & Family Millennium Plans
These plans are available to residents of Brooklyn, the Bronx, New York, Queens, Richmond, Nassau and Suffolk (Long Island), and Westchester counties. EmblemHealth offers a $0 monthly premium Essential Plan for adults aged 19-64 who meet eligibility requirements. This plan provides access to top providers and hospitals in the aforementioned counties, and there are no referrals required to see a specialist. Children and young adults can remain on a parent's plan until the age of 26.
Individual & Family Select Care Plans
The Select Care Plans are available to residents of 19 counties: Albany, Broome, Columbia, Delaware, Dutchess, Fulton, Greene, Montgomery, Orange, Otsego, Putnam, Rensselaer, Rockland, Saratoga, Schenectady, Schoharie, Sullivan, Ulster, Warren, and Washington. Similar to the Millennium Plans, children and young adults can stay on a parent's plan until age 26.
EmblemHealth Essential Plan (with Adult Dental and Vision)
This plan is available year-round through the New York State of Health Marketplace. It has a $0 monthly premium, no deductible, and no referrals are required to see a specialist. Members can also access a primary care physician, mental health professional, or dermatologist virtually with the Teladoc P360 benefit at no extra cost. Eligibility for this plan is based on income and other factors.
EmblemHealth Millennium Plans
EmblemHealth offers four Millennium Plans: Platinum, Gold, Silver, and Bronze. The Platinum plan is ideal for those who require frequent care, as it has a $0 deductible and includes preventive care and telemedicine. The Gold plan is a more affordable option for those who visit the doctor often, with a low deductible and drugs included before the deductible. The Silver and Bronze plans are suitable for those who go to the doctor for regular visits, with one primary care provider (PCP) visit before the deductible and drugs included before the deductible. All four plans include no-cost preventive care and telemedicine.
EmblemHealth Select Care Plans
Similar to the Millennium Plans, EmblemHealth offers Platinum, Gold, Silver, and Bronze Select Care Plans. The Platinum plan has a $0 deductible and includes preventive care and telemedicine. The Gold plan has a low deductible and includes drugs before the deductible. The Silver plan is suitable for those who go to the doctor for regular visits, with one PCP visit before the deductible, drugs before the deductible, and no-cost preventive care. The Bronze plan is for those who don't seek frequent medical care but still want health insurance coverage, with three PCP visits before the deductible. All four plans include telemedicine.
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Medicare and Medicaid
EmblemHealth is one of the largest not-for-profit health insurers in the United States, serving over three million people in New York City and the tristate area. They offer a range of health insurance plans, including Medicare and Medicaid, to meet the diverse needs of individuals and families.
Medicare is a federal program that primarily serves people aged 65 and over, providing them with access to affordable healthcare. It covers a range of services, including hospital stays, doctor visits, prescription drugs, and more.
Medicaid, on the other hand, is a state and federal program that provides health coverage for people with low incomes, families and children, people with disabilities, and those who meet other specific criteria. EmblemHealth offers state-sponsored Medicaid Managed Care plans, including Enhanced Care and Enhanced Care Plus (HARP). These plans provide comprehensive health, vision, and dental coverage at little to no cost for eligible individuals and families.
The Enhanced Care plan, for instance, has no monthly premium payments, though pharmacy copays may be required in certain cases. Eligibility for this plan is restricted to residents of specific counties, including Bronx, Kings, Nassau, New York, Queens, Richmond, Suffolk, and Westchester. Additionally, EmblemHealth's Medicaid Managed Care plan covers preventive and diagnostic medical care, such as routine and sick visits to primary care physicians, eye and hearing exams, prenatal care, dental care, and more.
EmblemHealth's Medicaid plans also offer specialized services for children and youth under 21, including Special Services for Children, which provides additional support for mental health and substance use needs at no extra cost. This includes services provided at home or within the community, such as the Article 29-I Voluntary Foster Care Agency (VFCA) Health Facilities, which promote the wellbeing and positive outcomes for children in foster care.
In summary, EmblemHealth's participation in Medicare and Medicaid programs demonstrates its commitment to making quality healthcare accessible and affordable for all, including those covered by these essential government-sponsored insurance plans.
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Employer insurance plans
EmblemHealth is one of the largest not-for-profit health insurers in the United States, serving over three million people in New York City and the tristate area. The company has been in operation for 80 years, providing affordable, quality health coverage to New York businesses.
EmblemHealth offers a range of insurance plans for employers, including small and large groups, labor unions, higher education, and more. Their plans are designed to meet the needs of employers and their employees, providing access to quality healthcare at reasonable prices.
One of the key advantages of EmblemHealth's employer plans is their broad access for large commercial groups and labor unions. These plans offer quality coverage at competitive rates, making them an attractive option for members living and working in New York.
The company also understands the importance of convenience and accessibility. Their new portal technology allows employers and employees to manage various administrative functions from anywhere, at any time. This includes functions such as finding participating doctors, healthcare professionals, and hospitals.
Additionally, EmblemHealth has strong partnerships with local providers and hospitals, which translates into best-in-class discounts for employees. They offer access to centers of excellence, including Memorial Sloan Kettering Cancer Center, Hospital for Special Surgery, Montefiore, and more.
EmblemHealth also provides a range of product designs, cost-sharing options, and pricing choices for employers to choose from. They offer easy-to-implement workplace wellness programs, telemedicine services, and free classes and in-person support through their Neighborhood Care centers.
Overall, EmblemHealth's employer insurance plans are designed to keep businesses and their employees thriving by providing accessible, affordable, and high-quality healthcare options.
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Insurance plan selection tips
EmblemHealth is one of the largest not-for-profit health insurers in the US, serving over three million people in New York City and the tristate area. They offer a range of health insurance plans for individuals and families, with benefits such as $0 monthly premiums, large networks of providers, and no referrals required to see specialists.
Know your options:
Firstly, it's important to know where to look for insurance plans. If you're 65 or older, you're most likely eligible for Medicare. For those under 65, employer-based insurance is an option, with the employer typically covering a significant portion of the premium costs. There's also Medicaid for people with low incomes, and for everyone else, there's Healthcare.gov, where you can shop for insurance in the Affordable Care Act marketplaces.
Review your needs:
Consider your current and future health needs. Do you require insurance for a catastrophic event, or do you have ongoing health issues that need coverage? Think about the types of healthcare services you and your family will need, such as physical exams, screenings, or specialist care.
Understand the terminology:
Get familiar with insurance terms like premium, deductible, co-payment, and health reimbursement account. Understanding these terms will help you evaluate the true overall cost of different plans and make an informed decision.
Compare costs:
Don't just focus on the monthly premium; consider other costs as well. Compare the estimated total yearly costs, including deductibles, co-payments, and expected healthcare usage. This will help you balance premiums, deductibles, and other expenses to find a plan that fits your needs.
Choose quality:
Don't base your decision solely on costs. Consider the quality of care offered by different plans. Look for plans that provide access to highly-ranked hospitals and clinics, as well as a full spectrum of healthcare options, including wellness programs, virtual appointments, and mobile health apps.
By following these tips and considering your specific needs, you can make a more informed decision when selecting an insurance plan.
Frequently asked questions
EmblemHealth is a health and wellness company that provides insurance plans, primary and specialty care, and wellness solutions. It is one of the nation's largest not-for-profit health insurers, serving over three million people in New York City and the tristate area.
EmblemHealth offers a range of insurance plans, including individual and family plans, Medicare Advantage Plans, and employer plans for small and large groups, labor unions, higher education, and more.
When choosing a health insurance plan, consider the following: the monthly cost, whether your doctors are in the network, the plan's drug coverage, and the deductible and co-pays.
In-network providers are those who accept your health insurance plan, while out-of-network providers do not.
EmblemHealth was born out of the idea that people needed protection from financial hardship due to accidents or illnesses during the Great Depression in the 1930s. Two early health insurance companies, Group Health Incorporated (GHI) and Health Insurance Plan of Greater New York (HIP), later merged to become EmblemHealth.
